Acta Scientific Otolaryngology (ASOL)

Volume 1 Issue 4 December 2019

Research Article

Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

BPS Tyagi1,2* and Mamatarani Rout3

1
Head of Department of ENT, Colombia Asia Hospital Ghaziabad
2
Head of Department of ENT, Harsh ENT Hospital, Ghaziabad
3
Junior Consultant Department of ENT, Harsh ENT Hospital, Ghaziabad
*Corresponding Author: BPS Tyagi, Head of Department of ENT, Colombia Asia Hospital and Harsh ENT Hospital, Ghaziabad.
Received: September 19, 2019; Published: November 22, 2019

Abstract
Sensorineural hearing loss is the collective term for hearing damage to the cochlea and auditory nerve, and is by far the most
common type of hearing loss in adults, accounting for over 90% of all cases. Sensorineural hearing loss is a heterogeneous disorder,
which can arise due to damage to pathway for sound impulses from the hair cells of inner ear to auditory nerve and less commonly
brain. Sensorineural hearing loss is a challenge to physicians, as it progresses with age and causes significant reductions in quality of
life and there are no treatments to reverse its effects, other than sound amplification with the use of hearing aids or direct auditory
nerve stimulation via cochlear implantation.
Platelet-rich Plasma (PRP) Therapy is a cutting edge procedure that is revolutionizing the hearing loss and deafness. Intratympanic
instillation of Platelet-rich Plasma (PRP) does wonder to the hair cells of inner ear,thus improving the hearing.
Keywords: Sensorineural Hearing Loss; Platelet Rich Plasma; Intratympanic

Introduction The efficacy of certain growth factors in healing various injuries

Platelet rich plasma (PRP) is a form of blood plasma that has
been enriched with platelets and growth factors. Platelets are tiny
cell fragments that stop bleeding and bruising and contain growth
factors and natural substances that encourage cellular growth and
stimulate healing.
Platelet-rich plasma (PRP), also known as autologous condi-
tioned plasma, is a concentrate of platelet-rich plasma protein
derived from whole blood, centrifuged to remove red blood cells.
Composition
There are four general categories of preparation of PRP based
on its leukocyte and fibrin content: leukocyte-rich PRP (L-PRP),
leukocyte reduced PRP (P-PRP; leukocyte reduced or pure PRP),
leukocyte platelet-rich fibrin and pure platelet-rich fibrin.
and the concentrations of these growth factors found within PRP
are the theoretical basis for the use of PRP in tissue repair.
The platelets collected in PRP are activated by the addition of
thrombin and calcium chloride, which induces the release of the
mentioned factors from alpha granules. The growth factors and
other cytokines present in PRP include:
• Platelet-derived growth factor.
• Transforming growth factor beta.
• Fibroblast growth factor.
• Insulin-like growth factor 1.
• Insulin-like growth factor 2.
• Vascular endothelial growth factor.
• Epidermal growth factor.
• Interleukin 8.
• Keratinocyte growth factor.
• Connective tissue growth factor.

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019): 02-05.
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss
Preparation
PRP is obtained from a sample of patients’ blood draw at the
time of treatment. A 30 cc venous blood draw will yield 3 - 5 cc of
PRP depending on the baseline platelet count of an individual, the
device used, and the technique employed. The blood draw occurs
with the addition of an anticoagulant, such as citrate dextrose A to
prevent platelet activation prior to its use.
PRP is prepared by taking blood from the person, and then put-
ting it through two stages of centrifugation designed to separate
PRP from platelet-poor plasma and red blood cells. This is usually
done by the clinic offering the treatment, using commercially avail-
able kits and equipment. The resulting substance varies from per-
son to person and from facility to facility.
PRP is prepared by a process known as differential centrifuga-
tion. In differential centrifugation, acceleration force is adjusted to
sediment certain cellular constituents based on different specific
gravity. There are many ways of preparing PRP. It can be prepared
by the PRP method or by the buffy-coat method. In the PRP meth-
od, an initial centrifugation to separate red blood cells (RBC) is fol-
lowed by a second centrifugation to concentrate platelets, which
are mainly white blood cells (WBCs) and platelets, from the under-
lying RBC layer.
PRP method
1. Obtain whole blood by venipuncture in acid citrate dex-
trose (ACD) tubes.
2. Do not chill the blood at any time, before or during plate-
let separation.
3. Centrifuge the blood using a ‘soft’ spin.
4. Transfer the supernatant plasma containing platelets
into another sterile tube (without anticoagulant).
5. Centrifuge tube at a higher speed (a hard spin) to obtain
a platelet concentrate.
6. The lower 1/3rd is PRP and upper 2/3rd is platelet-poor
plasma (PPP). At the bottom of the tube, platelet pellets
are formed.
7. Remove PPP and suspend the platelet pellets in a mini-
mum quantity of plasma (2-4 mL) by gently shaking the
tube.
Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019): 02-05.
03
Buffy coat method
1. Whole blood should be stored at 20°C to 24°C before cen-
trifugation.
2. Centrifuge whole blood at a ‘high’ speed.
3. Three layers are formed because of its density: The bot-
tom layer consisting of RBCs, the middle layer consisting
of platelets and WBCs and the top PPP layer.
4. Remove supernatant plasma from the top of the container.
5. Transfer the buffy-coat layer to another sterile tube.
6. Centrifuge at low speed to separate WBCs or use leuco-
cyte filtration filter.
Factors influencing PRP yield
Various factors influence the yield of PRP such as draw of blood;
speed, time and temperature of centrifugation and use of antico-
agulants.
Draw of blood
The clotting process is influenced from the time of the draw. To
avoid unintentional activation of platelets, most protocols use large
bore needles (> 22) to draw the blood.
Centrifugation
Separation of cellular constituents within blood can be achieved
by a process known as differential centrifugation.
Temperature
Temperature during processing is crucial to prevent platelet ac-
tivation. AABB manual recommends 21°C–24°C for centrifugation
of blood for obtaining PRP.
Activation of PRP
PRP activation prior to injection is another parameter that re-
quires further discussion. PRP can be activated exogenously by
thrombin, calcium chloride or mechanical trauma.
Mechanism of action: PRP has the potential to deliver a high
concentration of growth factors to target tissues by virtue of the
contents within the alpha and dense granules.
• Alpha granules contain seven fundamental growth fac-
tors: platelet-derived growth factors (PDG Faa, PDG Fbb
and PDG Fab); transforming growth factor beta (isoforms
TGFβ1 and 2); epithelial growth factor (EGF); and vascu-
lar endothelial growth factor (VEGF). These modulate cell
proliferation, cellular migration, differentiation, angio-
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

04

genesis and chemotaxis. The dense granules contain bioactive
agents including serotonin, histamine, dopamine, calcium and
adenosine; these can increase membrane permeability and
modulate inflammatory processes.
• Degranulation of these organelles results in the release of
pre-packaged growth factors, many of which have short half-
lives; therefore, greater effectiveness may result if they are
activated at or just before application. PRP has 3 - 5 times the
concentration of platelets normally found in wounds and the
resulting growth factor release following activation can fur-
ther stimulate cell proliferation and differentiation towards
tissue regeneration.
Discussion
Patients with sensorineural hearing loss comes with c/o
Plugged feeling or fullness in the ear, tinnitus, vertigo, hearing loss.
There is limited options for treatment of SNHL. Pharmacological
treatment such as antioxidant vitamins, coenzyme Q10 options are
very limited and clinically unproven. Such pharmaceutical treat-
ments as are employed are palliative rather than curative, and ad-
dressed to the underlying cause if one can be identified, in order
to avert progressive damage. Profound or total hearing loss may
be amenable to management by cochlear implants, which stimu-
late cochlear nerve endings directly. A cochlear implant is surgical
implantation of a battery powered electronic medical device in the
inner ear. Cochlear implant can be done under 3years of age which
in helpful. In our center we use PRP (platelet rich plasma) injection
as treatment for SNHL along with few medications.
Dose and time interval
Injection PRP 0.5 ml is injected intratympanic in round window
niche. S Can be monitored with audiogram results each time pa-
tient reviews. After injection patient should be on 5days of antibi-
otic, antihistamines and antacids and analgesics sos.
Side effects
No side effects has been reported.
Contraindications
Cancer, Chronic liver disease, Hemodynamic instability, Hypofi-
brinogenemia, Platelet dysfunction syndromes, Systemic disorder,
sepsis, Low platelet count.
Method
This case series study was carried out in ENT department of
Harsh ENT hospital, Ghaziabad during June 2018. All patients who
came with reduced hearing and fullness of ear were evaluated with
adequate investigations such as PTA, BERA.
The samples were assessed based on gender, age, duration of
hearing loss, laterality of hearing loss (unilateral, bilateral), type of
hearing loss (conductive, sensorineural) and presence of pathologi-
cal tissues (perforation, granulation, cholesteatoma, destruction
of ossicles). Based on audiogram 200 patients were selected with
pure sensorineural and mixed hearing loss. Study conducted in 200
patients over a period of 1 year. We instilled injection PRP 0.5ml
intratympanic in patients (n = 200). Injections were repeated every
3weeks with audiogram and compared with previous audiogram.
Out of 200 patients with injection PRP intratympanic, 172 pa-
tients were having improvement in hearing after 5 times of repeat-
ed injections and 28 patients didn’t show any improvement in hear-
ing. Out of 28 patients, 19 patients were above 70years and with
diabetes, and 9 were above 70 years old.
Out of 200 patients: total no of patients =200.
Age group in years No of patients
0-5 5
6-20 31
20-40 82
40-60 45
>60 37
Table 1
This table shows the maximum number of incidence of SNHL is
in the age group of 20 to 40 years of age.
Conclusions
Previously there was no specific treatment management for sen-
sorineural hearing loss except antioxidants and steroids. Introduc-
tion of platelet rich plasma in otorhinolaryngology and especially in
sensorineural hearing loss is doing revolutionary wonders in treat-
ment as we can see in our case study report.
Conflict of Interest
None.
Source of funds
Nil.

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019): 02-05.
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

05

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Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019): 02-05.